Organization
PEOPLE FIRST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARGARET KEDZIE COTA (STAFF COTA)
(262) 895-2322
Entity
Organization
Contact information
Practice address
677 E STATE ST, BURLINGTON, WI 53105-1639
(262) 763-9531
Mailing address
677 E STATE ST, BURLINGTON, WI 53105-1639
(262) 763-9531
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40733500
—
WI
Enumeration date
04/24/2008
Last updated
04/24/2008
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